Surgical instrument used to clamp a vessel or the like

ABSTRACT

A surgical instrument (1) is used to clamp a vessel (6), hollow organ or the like. The instrument has essentially a lock assembly (3) with a thread holder (4) and a shaft-like lock assembly holder (5) that can be coupled to the lock assembly. The lock assembly holder can be coupled with the lock assembly and has actuating members (7) for opening and closing the lock assembly thread holder. One thread end (12) is connected to the lock assembly (3) and with the aid of forceps (25) extended through the instrument can be grasped and drawn through two clamping jaws (9) spring-loaded towards each other. A loop is formed around the vessel (6) and the thread drawn to clamp off this vessel. After lock assembly (3) and lock assembly holder (5) have been detached from each other, the drawn-through thread end is clamped and the lock assembly holder (5) as well as the forceps (25) can then be removed. The thread (2) can be varied in tension as required and can be released again by opening the clamping device, preferably using the lock assembly holder (5).

FIELD OF THE INVENTION

The invention relates to a surgical instrument used to clamp (ligature)a vessel, hollow organ or similar part of the body by means of a threador rein, particularly in minimum invasive surgery.

BACKGROUND OF THE INVENTION

When applying a ligature, i.e. tying off vessels and the like, aso-called rein in the form of a thread, a plastic hose or a rubberthread is used for wrapping round the vessel. This rein is looped aroundthe vessel to be ligated and then knotted.

There is furthermore the possibility of using haemostatic forceps forligating, but they can be used only for a short period as they are inthe way in the operating area.

While a ligature is comparatively simple to apply if the abdomen isopen, considerable problems arise if the abdomen is closed andinstruments are introduced by way of trocar sleeves, because the roomfor movement is very restricted.

As a result, it is very time-consuming to apply the ligature. A furtherdrawback is that the tension of the ligature can no longer be alteredafter knotting.

A ligature system usable in conjunction with trocars is known from WO90/06725. It has a thread which can be drawn with its end into a cavityand can be fixed there by retaining means, particularly by lockingprofiles. For drawing in the end of the thread, a pulling element isprovided which can be fed through the trocar sleeve. Using the pullingelement, the thread end can be grasped and the loop can be drawn tight.Slackening of the ligature is not possible in this instance either.

When ligating a blood vessel or the like, it is therefore not possibleby slackening the ligature to check whether, for example, a suture istight. Hence neither is temporary blood circulation or temporaryperfusion of an organ possible in a simple manner. Therefore such casesnecessitate that in a complicated way the first ligature be severed andthen if necessary a new ligature be applied again.

SUMMARY OF THE INVENTION

The object underlying the present invention is to provide an auxiliarysurgical instrument of the kind mentioned at the outset, with the aid ofwhich a ligature can be applied in a significantly simpler fashion andin a short space of time. This is to be possible particularly also inminimum invasive surgery and when operating through trocar sleeves orthe like. In addition, it is possible for the ligature to be temporarilyloosened and then tightened again.

To accomplish this object it is proposed according to the inventionparticularly that the instrument has a lock assembly with a threadholder and a shaft-like lock assembly holder that can be coupled withthe lock assembly, and that the lock assembly holder has actuatingmembers for opening and closing the lock assembly thread holder.

Using this instrument, a ligature can be carded out in a simple mannerby putting the lock assembly with the aid of the lock assembly holder atthe vessel to be ligated and by the lock assembly there clampinglyholding the thread looped round the vessel. The lock assembly holder canthen be removed so as not to be in the way in the operating area. By thesame token, the lock assembly holder can also be coupled with the lockassembly again for removing or loosening the ligature. Using thisinstrument, the ligature can also be applied as well as possibly removedparticularly quickly; a factor of especial significance for a number ofoperations. It is furthermore advantageous that the handling is possiblewithout any difficulty, even in very confined conditions.

Suitably, the actuating members of the lock assembly holder at the sametime compose coupling elements for connecting to the lock assembly. Thiscontributes towards simple handling of the instrument. If the lockassembly holder is coupled with the lock assembly, the thread holder issimultaneously held in the open position. During uncoupling, the threadholder automatically assumes the clamping position and then holds theintermediate end of the rein fast. Additional actuation for clamping orreleasing the end of the rein is not necessary in this embodiment.

According to a further development of the invention it is proposed thatthe thread holder of the lock assembly has clamping elements for holdingat least one loop end of the rein or thread, and that preferably onethread end is fixed at the lock assembly and the other thread end isheld by the clamping elements. Thus the free thread end is firstconducted around the vessel or the like to be clamped and is then heldfast by the clamping elements after lock assembly and lock assemblyholder have been detached from each other.

It is especially advantageous if the clamping elements are configuredand arranged to be self-locking counter to the tensioning direction ofthe thread and if the clamping elements have clamping jaws spring-loadedin the clamping direction which are mounted for swivelling towards eachother and can be acted upon in the clamping direction by the tension ofthe thread.

As a result of this configuration of the clamping means and threadholder, the thread can still be retightened and tautened even after thelock assembly holder has been uncoupled and thus the thread tension canbe adjusted particularly well to the respective requirements.

The lock assembly preferably has a passage, particularly a centralpassage, for one thread end. The free thread end can be drawn throughthis passage to form a loop.

The lock assembly holder, particularly its shaft, suitably has apreferably central passage in alignment with that of the lock assemblyin the coupled position of lock assembly and lock assembly holder, andforceps are provided which fit through these passages and can beinserted from the outer end of the lock assembly holder.

Using the forceps or the like extended through the lock assembly holderand lock assembly, the free thread end looped around the vessel to beclamped can be grasped and passed through the clamping device. After thelock assembly holder has been uncoupled, the loop width can beappropriately adjusted by pulling the thread end.

One embodiment of the invention envisages that the lock assembly holderhas actuating and holding elements in the form of forcipated claspingjaws preferably having their inner surfaces adapted generally to theouter contour of the lock assembly and in the closed position engagingthe actuating projections to unclamp the thread. By this means, the lockassembly holder has a comparatively small outer cross section and thuscan also be introduced well through trocar sleeves for example.

Another embodiment of the invention contemplates that the clampingelements of the thread holder take the form of expanding jaws and have apassage therebetween for the thread, that the expanding jaws areprovided with an external clamping cone co-operating with a slidableclamping sleeve, that the clamping sleeve is spring-loaded in theclosing direction and that the clamping elements and the clamping coneare provided with contact points for the lock assembly holder or thelike for opening and closing the clamping elements. The thread isclamped here by the clamping elements being externally acted upon withthe aid of the slidable, spring-loaded clamping sleeve.

BRIEF DESCRIPTION OF THE DRAWINGS

Additional developments of the invention are recited in the furthersub-claims. The invention with its leading features will be described incloser detail below with reference to the drawings in which

FIG. 1 is a side view of an instrument embodying the invention, withlock assembly and lock assembly holder in a position detached from eachother,

FIG. 2 is an enlarged view of the lock assembly shown in FIG. 1,

FIG. 3 is a view of the end face of the lock assembly shown in FIG. 2,with the thread holder closed, FIG. 4 is the end face of the lockassembly in a view corresponding substantially to FIG. 3, but with thethread holder open,

FIG. 5 is a side view of the inner end of the lock assembly holder and

FIG. 6 is a view corresponding substantially to FIG. 5, but here withforceps extended through the lock assembly holder.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

A surgical instrument 1 (FIG. 1) serves to clamp a vessel or the like bymeans of a thread 2 (rein) and has essentially a lock assembly 3 with athread holder 4 and a lock assembly holder 5 here shown only in part. Toposition the lock assembly 3 at a vessel 6 to be clamped, the lockassembly 3 can be coupled with the lock assembly holder 5. The lockassembly holder 5 has for this purpose clasping jaws 7 adapted to openand close in a gripper-like fashion. In FIG. 1 the clasping jaws 7 areillustrated in an open i.e. gripping position, so that the lock assemblyholder 5 can be slipped with these clasping jaws over the lock assembly3.

The clasping jaws 7 simultaneously form actuating members for openingand closing the lock assembly thread holder 4. In the exemplaryembodiment shown, the thread holder 4 is in principle designed like aso-called curry haemostat. For this purpose clamping elements 8 areprovided which take the form of pivoted levers and at their inner endshave spring-loaded clamping jaws 9. These clamping jaws 9 clamp anintermediate thread 2. As a result of the position and configuration ofthe clamping elements 8, the passed-through thread 2 is selflockinglyheld. Therefore on the one hand the thread 2 can be drawn through theclamping elements 8 in the tensioning direction according to arrow Pf 1,but on the other hand the clamping of the thread is automaticallyincreased and thus the thread is securely held counter to thistensioning direction. A rubber ring 10 is applied to the clampingjawends of the clamping elements 8, so that in the unloaded position theclamping elements 8 assume the position depicted by continuous lines inFIG. 1.

The lock assembly 3 has a central passage 11 through which the onethread end can be passed and then also extends between the clasping jaws7 interfering with this passage 11 (cf. also FIGS. 3 and 4). The otherthread end 12 is fixed to the lock assembly 3, so that a loop is formedwhen a free thread end is drawn through the lock assembly, or morespecifically through its passage 11.

The clamping elements 8 resembling pivoted levers have swivel bearings13 located in the wall of the lock assembly body and traversingslit-like pockets 14 for the clamping elements 8 in the lock assemblycase.

The ends of the clamping elements facing away from the clamping jaws 9have actuating projections 15 continuing beyond the swivel bearings 13.In the position of the clamping elements 8 depicted by continuous linesin FIGS. 1 and 2, the actuating projections 15 project beyond the outerperiphery of the lock assembly 3 (cf. also FIG. 3).

If now the lock assembly holder with its clasping jaws 7 is slipped overthe lock assembly 3 and then the clasping jaws assume their closedposition shown in FIG. 5, the actuating projections

15 of the clamping elements 8 are engaged and swivelled inwards into thepockets 14. At the same time the thread holder 4 is opened against therestoring force of the rubber ring 10. This position of the clampingelements 8 is depicted by dashed lines in FIGS. 1 and 2.

The free ends of the clasping jaws 7 have inwardly directed offsets 16engaging with an annular groove 20 of the lock assembly 3 in the closedposition of the clasping jaws 7. In this position, the lock assembly 3and the lock assembly holder 5 are coupled together.

The passage 11 has a widening 26 in the region of the clamping jaws 9,so that there is sufficient room for the expansion of the clamping jaws9 and also for the restoring element (rubber ring 10). As is evidentfrom FIGS. 3 and 4, the clamping jaw-ends remote from the bearings areformed with tongues 17 composing grooved portions 18 for receiving therubber ring 10.

FIGS. 3 and 4 show in addition to passage 11, a further passage 19. Thethread end 12 to be secured can be passed through the passage 19 andalso fixed there if necessary. In the simplest case, the thread end 12is passed through the lock assembly 3, or more specifically throughpassage 19, from underneath and knotted at the other end.

The lock assembly holder 5 is shaft-like and is of a length adapted tothe respective operating conditions. At the inner end are the actuatingmembers in the form of clasping jaws 7 for engaging the actuatingprojections 15 of the clamping elements 8. These actuating memberssimultaneously form coupling elements for connecting to the lockassembly 3. For establishing the connection, the offsets 16 of theclasping jaws 7 engage with the annular groove 20 of the lock assembly3. Handle-like actuating means (not shown) for opening and closing theclasping jaws 7 may be provided at the outer end of the lock assemblyholder 5. The means for transferring this movement extend in theinterior of the lock assembly holder 5. The lock assembly holder 5 has atubular shaft member 21. Contained within this tubular shaft member 21is a longitudinally slidable inner tube 22. This movement is effectedfrom the outer end, by means of a corresponding handle element forinstance.

As may be seen particularly in FIG. 5, the swivel bearings 27 of theclasping jaws 7 are provided at the inner end of this inner tube 20.This end of the inner tube 22 with the swivel beatings 27 is somewhatproud of the inner end of the shaft member 21 forming an outer tube.

In the closed position (FIG. 5), the clasping jaws 7--as concerns theirouter contour compose an extension of the shaft member 21 and are eachformed by a channel-like tubing 10 section halved substantiallylengthwise. The swivel beatings 27 are situated near the end of theshaft member 21 in the region of the centre longitudinal plane, so thatthe clasping jaws 7 are capable of swinging out in a gripper-likefashion as is indicated in FIG. 6 and by dashed lines in FIG. 5.

In order that this gripper movement takes place in synchronism by bothclasping jaws 7 during a longitudinal movement of the inner tube 22, theclasping jaws 7 are in each case coupled with push-pull arms 23 (cf.FIG. 1) in laterally spaced relationship to the axis of the swivelbearings. The other ends of the push-pull arms are connected to theshaft member 21. By this means a positive control is constituted,bringing about an opening and closing swivel movement of the claspingjaws 7 as inner tube 22 moves relative to shaft member 21.

To swivel open the clasping jaws into a gripping position (FIG. 6), theinner tube 22 is moved slightly in the direction of arrow Pf 2, hencetowards the inner end, so that the axis of the swivel bearings is alsoshifted further outwards. Since the clasping jaws are externallyconnected in the present instance by way of push-pull arms 23 flexiblycoupled on the one hand to the clasping jaws 7 and on the other hand tothe shaft member 21, the clasping jaws 7 are swivelled open into thegripping position at the same time as the swivel bearings 27 aredisplaced outwardly. Instead of the push-pull arms 23 provided, onemight also provide pulling elements operative for the swivel-openmovement and stops operative between the shaft member and the claspingjaws for the closing movement.

To apply a ligature, one proceeds as follows:

In the initial position, the lock assembly 3 is connected to the lockassembly holder 5 and held by the clasping jaws 7. The one end 12 of thethread 2 is connected to the lock assembly 3. The thus configuredinstrument is then brought, inner lock assembly end first, into theregion of the vessel 6 to be ligated.

The inner tube 22 of the lock assembly holder 5 has throughout itslength an inside cavity 24 indicated by dashed lines in FIGS. 1 and 2.Forceps 25 can now be passed through this inside cavity 24 and throughthe lock assembly passage 11 in alignment therewith in the coupledposition of lock assembly holder and lock assembly (FIGS. 1, 2 and 6),and can grasp the free end of the thread 2 looped round the vessel 6.Since in this position the actuating projections 15 of the clampingelements 8 are engaged by the clasping jaws 7, the clamping jaws 9 arein the open position, as is indicated by dashed lines in FIGS. 1, 2 and4. In this position the forceps 25 can thus be passed without hindrancethrough the instrument. The free thread end grasped by thepassed-through forceps 25 is then drawn through the lock assembly 3. Thelock assembly holder 5 can then be detached from the lock assembly 3 byopening the clasping jaws 7, whereby the clamping elements 8automatically swivel into the clamping position and the drawn-throughthread is clamped between the clamping jaws 9. Using the forceps 25, thethread 2 can be tautened in the direction of arrow Pf 1 and the tensionadapted to the respective conditions.

By the same token, the special design of the thread holder 4 (curryhaemostat) prevents any slackening of the thread tension because theclamping elements 8 act self-lockingly. Once the appropriate tension ofthe thread or rein has been set, only the lock assembly 3 remains in theregion of the clamped vessel 6.

The tension of the rein can be slackened again in case of need. Forthat-purpose the thread end drawn through the lock assembly 3 is graspedby the forceps extended through the lock assembly holder 5, as is shownin FIG. 6. The somewhat tautened thread can then serve as a guiding cordfor the lock assembly holder 5 which is slid, along the forceps and thethread they hold, onto the lock assembly 3 quickly and without anydifficulty. With the aid of the lock assembly holder 5 the clampingelements 8 are swivelled so that the thread 2 is released and can beslackened so far as to enable, for instance, the vessel 6 to be suppliedwith blood. In case of need, the rein can then be tightened again toclamp the vessel.

As already mentioned above, in the closed position (FIG. 5) the claspingjaws 7 compose an extension of the shaft member 21 and neither is thereany cross-sectional enlargement in the region of these clasping jaws 7.Even when the lock assembly 3 is in the held and coupled condition, theinstrument 1 as a whole forms a substantially smooth, slender tubelength, so as also to lend itself especially well to use in operationsthrough trocar sleeves.

I claim:
 1. In combination, a surgical instrument (1) and a lockassembly (3) which is applied by the surgical instrument to clamp one ofa vessel, a hollow organ and a body part using a thread, the combinationcomprising:a lock assembly (3) having a thread holder (4) which ismovable between an open position, in which a thread can be inserted orreleased, and a closed position, in which the thread is held firmly inposition, such that a thread can be applied around the one of thevessel, hollow organ and body part and inserted in the thread holderwhen the thread holder is in the open position and be held when thethread holder is actuated to the closed position to act as a releasableclamp; and a surgical instrument (1) having a shaft with a lock assemblyholder (5) located at a distal end thereof, the lock assembly holderincluding actuating members that are releasably coupled with the lockassembly (3) in a coupled position for positioning the lock assembly andmoving the thread holder (4) between the open and closed positions toeffectuate clamping.
 2. The combination of claim 1 wherein the actuatingmembers of the lock assembly holder (5) include coupling elementsconnected to the lock assembly (3).
 3. The combination of claim 1wherein the thread holder (4) of the lock assembly (3) includes clampingelements (8) which are adapted to hold at least one end of a threadloop.
 4. The combination of claim 3 wherein the clamping elements (8)include clamping jaws (9) which are spring-loaded in a clampingdirection, the clamping jaws (9) being mounted for swivelling movementtowards each other and being self-locking counter to a tensioningdirection of the thread (2) such that the clamping jaws (9) are adaptedto be self-locking when acted upon by thread tension.
 5. The combinationaccording to claim 3 wherein the clamping elements (8) include actuatingprojections (15), the actuating members of the lock assembly holder (5)include actuating elements (7), and the actuating projections (15) areadapted to be acted upon by the actuating elements (7) of the lockassembly holder (5) to move the thread holder (4) to the open positionfor unclamping the thread.
 6. The combination of claim 1 wherein thelock assembly (3) includes a body having a generally central passage(11) defined therethrough which is adapted to receive at least onethread end and for passing a gripping instrument (25) therethrough. 7.The combination of claim 6 wherein the lock assembly holder (5) has acentral passage (24) defined therethrough which is in alignment with thecentral passage of the lock assembly (3) in the coupled position of lockassembly (3) and the lock assembly holder (5), the surgical instrumentfurther comprising forceps (25) which are insertable through saidpassages.
 8. The combination of claim 7 wherein the lock assembly holder(5) has a shaft member (21) which includes inner and outer ends andclasping jaws, the clasping jaws (7) of the lock assembly holder (5)being swivel-mounted at the inner end of the shaft member (21), an innertube (22) being coaxially located within the shaft member (21) andconnected to the clasping jaws (7) for opening and closing the claspingjaws (7), the inner tube (22) having an inner end which is provided withswivel bearings (27) for connection to the clasping jaws (7).
 9. Thecombination of claim 1 wherein the lock assembly holder (5) comprises anactuating and holding element having forcipated clasping jaws (7) whichinclude inner surfaces, the clasping jaws being movable between a first,open position, and a second, closed position, the lock assembly (3)includes actuating projections (15) having an outer contour, the innersurfaces of the clasping jaws (7) being complementary to the outercontour of the lock assembly actuating projections (15) such that theclasping jaws (7) engage the actuating projections (15) in the second,closed position for actuating the thread holder (4) to the open positionfor unclamping the thread.
 10. The combination of claim 9 wherein thelock assembly holder (5) includes a shaft member (21) having inner andouter ends, the clasping jaws (7) of the lock assembly holder (5) areswivel-mounted at the inner end of the shaft member (21), and actuatingmeans for opening and closing the clasping jaws (7) are located at theouter end of the lock assembly holder.
 11. The combination of claim 1wherein the lock assembly (3) has a substantially cylindricalconfiguration and comprises a lock assembly body having an outer contourand an axial, generally centrally located passage (11) therethrough, andthe thread holder (4) includes clamping elements (8) swivel-mounted onthe lock assembly body, the clamping elements (8) include a first endwith clamping jaws (9) located in a region of the passage (11) and asecond end with actuating projections (15) which extend outside of theouter contour of the lock assembly body.
 12. The combination of claim 11wherein the clamping elements (8) include grooved portions (18) and arespring-loaded into the closed position by at least one rubber ring (10)mounted in the grooved portions (18).
 13. The combination of claim 11wherein the lock assembly (3) has a second passage (19) which extendsparallel to the generally centrally located passage (11) and is adaptedfor securing one end (12) of the thread.
 14. The combination of claim 1wherein the thread holder (4) includes clamping elements (8) whichcomprise expanding jaws, a generally centrally located passage extendsthrough the lock assembly between the clamping jaws for the thread, anexternal clamping cone which co-operates with a slidable clamping sleevebeing provided on the expanding jaws, the clamping sleeve isspring-loaded in a closing direction of the expanding jaws, and theclamping elements and the clamping cone are provided with contact pointsfor the lock assembly holder for opening and closing the clampingelements.
 15. The combination of claim 14 wherein the thread holder (4)includes a second sleeve which is longitudinally slotted in the regionof the expanding jaws having a flared outside cross section, and theannular clamping sleeve is slidably mounted upon the second sleeve. 16.The combination of claim 14 wherein one of the expanding jaws and theclamping sleeve have substantially axially extending extensions ascontact points for the lock assembly holder, the actuating members arein spaced relationship to one another in the clamping position andinclude openings therethrough.